Subject: CDC Summary Date: 6/15/93 (267 lines) From: National AIDS Info Clearinghouse Copyright 1993, Information, Inc., Bethesda, MD AIDS Daily Summary June 15, 1993 The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold. Copyright 1993, Information, Inc., Bethesda, MD "Haitians With H.I.V. Leave Cuba Base for Lives in U.S." New York Times (06/15/93), P. A20 (Rohter, Larry) A total of 27 HIV-positive Haitian refugees were released from the U.S. Naval base at Guantanamo Bay, Cuba, yesterday after almost 20 months of confinement. The release is the result of a federal judge's June 8 decision that the U.S. policy of prohibiting immigration of HIV-positive refugees even when they qualify for political asylum was "outrageous, callous, and reprehensible." Judge Sterling Johnson Jr. of the Federal District Court in Brooklyn also chastised the Clinton administration for inflicting on the Haitians "the kind of indefinite detention usually reserved for spies and murderers." The departure of the group of 21 adults and six children was the first step toward closing the military detention center, as ordered by Judge Johnson. Col. Raymond A. Barbeau, commander of the camp, said he expected the remaining 113 Haitian refugees to depart for the United States "in the next 10 days to two weeks." Despite claims by the refugees and many others who visited the camp that it was a "HIV prison camp," Col. Barbeau said it was equipped with a chapel, a beauty shop, weight room, and playground. Still, residents complained of being confined by barbed wire, which they said was removed over the weekend in anticipation of a visit by the media yesterday. One refugee said, "Being sick is not a crime. We have done nothing to deserve this treatment." Many of the HIV-positive Haitians also questioned whether they were actually infected with the virus. Some believe they were victims of a U.S. government plot, and hope that once they arrive in the United States they will be able to learn their true medical status. Related Story: Washington Post (06/15) P. A1. "Conference Ends With Little Hope for AIDS Cure" New York Times (06/15/93), P. C1 (Altman, Lawrence K.) The Ninth International Conference on AIDS held last week in Berlin did not reveal any cure for the disease, and researchers say the only way to avoid the malady is through prevention practices like safe sex. Dr. Lars O. Kallings, a Swedish AIDS expert, said to colleagues at the meeting, "The AIDS epidemic is an emergency, but society is responding as if it were not." Health-care professionals have stressed the multiplier effect of prevention: each case prevented reduces the chance of further spread and additional deaths. The most powerful argument for prevention is a humanitarian one. However, for political leaders who are concerned about cost, the economic aspect of prevention is critical, as each case costs tens of thousands of dollars to treat. Dr. James W. Curran, who heads the AIDS program at the Centers for Disease Control, recommended that a national meeting concentrating entirely on prevention be held in the United States. The meeting could unite many of the various groups devoted to family planning, treatment of sexually transmitted diseases (STDs), HIV prevention, and public health, which all have a similar goal but work separately. Another objective would be to emulate successful programs and identify deterrents to prevention. Although AIDS researchers still have much to learn about the disease, experts feel confident that they have accumulated more than enough evidence about steps that can significantly reduce the risk of HIV transmission. "Accusations of Bias Divide AIDS Groups" Boston Globe (06/14/93), P. 17 (Hohler, Bob) HIV-positive IV-drug users in Boston claim that a state social service AIDS agency has discriminated against them because they are not homosexuals. Last week, nearly a dozen recovering IV-drug users infected with HIV and allied with the National AIDS Brigade presented this picture, alleging that the AIDS Action Committee of Massachusetts disregarded them because they were drug users rather than homosexuals. While the AIDS Action Committee ardently denied the claims, several AIDS activists said the complaints signify growing tensions between the two groups most profoundly affected by AIDS. Stephanie Turlo, an AIDS patient and a volunteer for the National AIDS Brigade, said, "The disease may not discriminate, but unfortunately people infected with it often do." The recovering drug addicts' complaints have emerged after a bitter fund-raising dispute between the AIDS Action Committee and the National AIDS Brigade, a grass-roots group that distributes clean needles to IV-drug users. The AIDS Brigade was accused of "deliberate fraud" by the AIDS Action Committee for collecting donations at the recent annual AIDS Pledge Walk, sponsored by the committee. Jon Parker, the brigade's director, said that the AIDS Action Committee did not use much of the money raised for AIDS-related matters, and added that the committee is dominated by homosexuals who "blatantly discriminate" against the HIV-infected IV-drug users. However, Larry Kessler, director of AIDS Action, said that about a third of the AIDS action committee's 1,400 clients are IV-drug users. "AZT Protection Incomplete in Accidental Exposures" Reuters (06/14/93) (Mikkelsen, Randall) Philadelphia--The antiviral drug AZT, used to treat AIDS, provides incomplete protection at best against HIV in occupational exposures, according to a report in the Annals of Internal Medicine by researchers from the Centers for Disease Control. Health-care workers studied by the CDC have increasingly taken AZT after accidental exposures to HIV. However, a health-care worker involved in the study tested positive for HIV after being exposed to the virus and taking subsequent treatments of AZT, or zidovudine. "If zidovudine is protective, any protection afforded is not absolute," the report said. The research is part of a long-term project by the CDC in which health-care workers have voluntarily reported accidental HIV exposures since 1983. The report said that four of 1,103 workers in the study who were accidentally exposed to HIV later tested positive for HIV. One of those four was pricked by a tainted needle and became infected despite taking AZT two hours after the injury. Also, the report said the CDC was aware of eight cases where AZT failed to prevent infection with HIV after an accidental exposure. Preventive use of the drug by health-care workers is rising rapidly. Among those followed by the federal project, use of AZT after an occupational exposure increased from five percent in late 1988 to between 40 and 50 percent after 1990. An accompanying editorial said, "Those considering treatment with zidovudine should be fully informed about its unproven value in this setting. Fortunately, most exposed health-care providers can be reassured that the statistical risk for infection is low." "A Personal Side for Many in Pledge Walk for AIDS" St. Louis Post-Dispatch (06/14/93), P. 3A (Kirkland, Stephen) The fourth annual St. Louis AIDS pledge walk on Sunday involved about 5,000 participants and raised more than $200,000 for local AIDS groups, according to event organizers. Several participants had family, friends, or co-workers infected with HIV. "I just want to help find a cure so other people don't become ill with this terrible disease," said one participant. Those involved in the event walked, skated, jogged, pedaled bicycles, and pushed carts or baby carriages. "What makes this different from other fund-raisers is that the money stays in St. Louis," said Roseann Weiss, president of The AIDS Foundation of St. Louis, which organized the walk. The foundation has dispersed more than $700,000 since 1988 for AIDS education, treatment, and counseling. In the St. Louis area, more than 2,000 AIDS cases have been documented, and the disease has caused 863 deaths since it first emerged more than a decade ago. "Researchers Urged to Address Ethical and Social Issues Before Initiating HIV Vaccine Trials in Developing Countries" Business Wire (06/10/93) Berlin--Before large-scale trials of HIV vaccines are launched in developing countries, important social and ethical issues must be addressed by researchers, government leaders, and drug companies, according to a team of international scientists. The group, led by Dr. Peter Lurie, a health policy analyst at the University of California--San Francisco Center for AIDS Prevention Studies, provided vaccine testing guidelines last Thursday at the Ninth International Conference on AIDS in Berlin. Because developing countries are being targeted for the vaccine trials, the international group is intervening so that the tests will not only be effective from a research standpoint, but acceptable to the host countries and conducted ethically. Both therapeutic and preventive vaccines are expected to be tested in major trials. The group of researchers cautioned that subjects in vaccine trials might prematurely consider themselves protected from HIV and not take risk behavior precautions, so they urged frequent and thorough counseling and education for all individuals participating in the studies. In addition, the group advised that widespread information campaigns be conducted before the start of any trial to guarantee that recruitment efforts include all segments of the population and ease worries about vaccine testing. They also suggest that the scientists in developing countries be actively involved in all phases of the trial. Moreover, effective vaccines should be offered to citizens of the host country free of charge or, at least, at significantly reduced prices. The four locations proposed by the World Health Organization for the vaccine trials are Brazil, Uganda, Rwanda, and Thailand. "Mystery to AIDS Virus Spurs Studies" Reuters (06/10/93) (Johnson, Cynthia) Berlin--Questions about why some people seem to have a natural resistance to HIV were raised last week at the Ninth International Conference on AIDS. Dean Mann, of the U.S. National Cancer Institute in Frederick, Md., thinks the rate HIV-positive patients develop full-blown AIDS depends on their tissue type. "There appears to be a protective haplotype that slows the progress of the virus," said Mann. A haplotype is a combination of molecular markers known as human leukocyte antigens (HLA), widely used to determine tissue compatibility between transplant recipients and donated organs. He said, "Our study suggests that HLA typing may be useful to identify people who are at risk of rapid disease progression and who would be candidates for aggressive treatment.... It also suggests that interpretation of therapeutic trials may be confounded if the HLA type is not considered.... Even before HIV had been identified as the AIDS virus, we wanted to see if there were genetic elements that influenced the progression of the disease." Genes that encode the HLAs exist in multiple forms, called alleles. This multiple allelism allows for each HLA to exist in many varieties, so that the number of possible HLA combinations, or haplotypes, reaches into many thousands. Another study has found that 24 out of 265 prostitutes researched in Nairobi have remained free of HIV even though they had continually been exposed to the virus. The researchers in this study believe that the resistant women had a certain type of allele which appeared to make them five to six times less likely to contract HIV. "British AIDS Funding: Garbled Story Reaches U.S." AIDS Treatment News (05/21/93) No. 175, P. 7 (James, John S.) Reports that large cuts in AIDS funding are set in the United Kingdom have reached the United States, where the fear is that the cuts could spread to this country. Some attendees at the International Conference on AIDS are reportedly changing their airline tickets so they can demonstrate in London on the way home. However, the cuts are not as drastic as rumored. According to AIDS writer and activist Edward King, two proposed events have been confused. One is a new policy setting a 150,000 pound limit per year in "Section 64" government funding to a voluntary organization. The limit will have a serious affect on the Terrence Higgins Trust, the U.K.'s largest AIDS service organization, which will see a drop from 450,000 pounds to 150,000 pounds over the next three years. Only three voluntary organizations in the nation are large enough to be affected by the limit. The other, unrelated, policy change involves U.K. AIDS education programs, which will move away from urging everyone to practice safe sex to just urging high-risk groups to do so. The policy change is related to the fact that the disease has not broken out in the general heterosexual population as expected. "Slowing the Spread of HIV: Agenda for the 1990s" Science (05/28/93) Vol. 260, No. 5112, P. 1266 (Merson, Michael H.) The AIDS pandemic continues to grow 12 years after it was first described, writes Michael H. Merson for Science. But HIV, which can be prevented from spreading, is probably more well-understood than any other virus. In the 1990s, the question is whether prevention efforts should be continued, but on a wider scale, or whether scientists should combat the virus from a new angle. Slowing transmission of HIV can limit the AIDS pandemic because AIDS is primarily a sexually transmitted disease. According to the World Health Organization, by mid-1993, over 13 million young people and adults will have contracted HIV since the pandemic began, while about 1 million children have become infected perinatally. HIV infections, amounting to more than 8 million in Saharan Africa and more than 1.5 million in North America and Europe, are on the rise in the Caribbean, North Africa, the Middle East, eastern Europe, and central Asia. Asia, especially the southern and southeastern parts, are seeing the steepest rises. Paying for the care of infected AIDS patients is proving to be a problem, as are the indirect costs of the epidemic. Consequently, while it is important to find treatments for HIV infection, writes Merson, it is important to prevent further spread of the virus, for instance through vaccines, through changes in sexual behavior, and through care of sexually transmitted diseases. The scientific community, Merson concludes, must overcome challenges involving education, objectivity, priority prevention research, and research agendas before it can adopt an expanded AIDS research and intervention effort.